Jharkhand

Bokaro

CC/60/2021

Gopal Murarka - Complainant(s)

Versus

Cholamandalam MS General Insurance Company Ltd. - Opp.Party(s)

Ranjeet Kumar

04 Feb 2023

ORDER

          District Consumer Disputes Redressal Commission, Bokaro

Date of Filing-30-12-2021

Date of final hearing-04-02-2023

 Date of Order-04-02-2023

Case No. 60/2021

Gopal Murarka S/o M L Murarka,

R/o House No. 226, Rana Pratap Nagar, Chas,

 P.O. & P.S. Chas, District- Bokaro, Jharkhand

Vs.

Cholamandalam MS General Insurance Company Ltd.

Having Registered Office at 2^nd Floor,

“DARE HOUSE” 2 N.S.C. Bose Road, Chennai-600001

Having Local Office at Flat No. 301, 3^rd Floor,

Tiwari, Circular Road, Ajit Enclave, Lalpur, Ranchi, Jharkhand 834001

 

 Present:-

                             Shri Jai Prakash Narayan Pandey, President

                  Smt. Baby Kumari, Member

 

PER- J.P.N Pandey, President

-Judgment-

1. Complainant has filed this case with prayer for direction to O.P. for payment of Rs. 74,044/- on account of medical expense incurred during his treatment and for grant of compensation Rs. 1,00,000/- and Rs. 20,000/- as legal expense.

2.   Complainant’s case in brief is that he has obtained Mediclaim policy from O.P. Cholamandalam M.S. General Insurance Co. Ltd. Vide policy No. 2876/000/831/0027/000/02 which was valid on 11.10.2020 meanwhile he suffered with chest pain at Ranchi hence he rushed Rajendra Institute of Medical Sciences Hospital, Ranchi where he was admitted and it was detected that there is need of cardiac surgery hence on 12.10.2020 cardiac surgery was done and he was discharged on 13.10.2020 from the hospital, during which he paid Rs. 74,044/- for treatment. Inspite of submission of claim form and demanded documents O.P. has repudiated the claim of the complainant on the baseless ground hence there is deficiency in service thereafter, this case has been filed.

3. Inspite of due service of notice non appeared on behalf of O.P. hence vide order dt. 06.06.2022 case has proceeded ex-parte against O.P.

4. To prove its case complainant has produced photo copy of  Insurance policy   (Annexure-A) which is valid from 01.12.2019 to 30.11.2020 in this way on the date of treatment complainant was having valid and effective Mediclaim policy and it is for the complainant, his wife and daughter for the sum insured Rs. 10,00,000/-. Annexure –B is the photo copy of investigation reports related to the complainant, annexure-c is the photo copy of payment receipts through which complainant has paid Rs. 74,044/- as claimed in this case, annexure-D is the photo copy of the discharge sheet issued by RIMS, Ranchi showing that complainant was admitted in the hospital on 11.10.2020 and discharged on 13.10.2020 after cardiac procedure etc. Annexure-E is the postal receipt and track report through which all relevant papers have been send to the O.P. for settlement of claim. Annexure-F is the photo copy of claim repudiation letter accordingly claim has been closed on account of non production of demanded documents, however, O.P. has reiterated to pay admissible claim fairly and promptly. In this way it is apparent that claim has not been rejected rather it has been closed. Annexure-G is photo copy of the Adhar Card of the complainant, Annexure-H is photo copy of cancelled cheque submitted by the complainant to the O.P. Annxure-H is photo copy of the claim form submitted by the complainant before the O.P. for settlement of his claim.

5. On careful perusal of the papers submitted by the complainant it is very much clear that during treatment of the complainant in respect to cardiac ailment at RIMS, Ranchi he paid total Rs. 71,944/- ( as it is apparent from the receipts filed in this case) and it has not been reimbursed by the O.P. inspite of submission of all available papers. Therefore, we are of the view that there is deficiency in service by the O.P. and complainant is entitled to get relief in the following manner.

6. Prayer of the complainant is being allowed in the following manner :-

          O.P. Cholamandalam M.S. General Insurance Co. Ltd. is here by directed to pay Rs. 71,944/- to the complainant within 60 days from receipt /production of the copy of this order, failing which O.P. shall pay interest @ 10% per annum on that very amount from 30.12.2021 (the date on which case has been filed). Further O.P. is directed to pay Rs. 10,000/- as compensation and Rs. 5000/- as litigation cost within above mentioned period.

(J.P.N. Pandey)

                                                                                      President

                                                                            

                  

                                                                               (Baby Kumari)

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